A SUCCESSFUL CASE OF BIFRONTOTEMPOROPARIETAL DECOMPRESSIVE CRANIECTOMY WITH CORONARY SKIN INCISION FOR SEVERE HEAD INJURY

Abstract

　　A 17-year-old man was injured in a bicycle accident. On admission his GCS was E2V3M5 with restlessness, and initial head CT revealed bifrontal brain contusion and right subdural hematoma. After we performed right burr hole surgery for the hematoma, we started hypothermia and barbiturate therapy while monitoring ICP. On hospital day 2, ventricular drainage was performed when ICP reached more than 30 mmHg. On day 4, ICP reached high values again, and we confirmed brain swelling without mid-line-shift on CT. We decided to perform bifrontotemporoparietal decompressive craniectomy with coronary skin incision. After the surgery, the patient quickly finished intensive care, and his level of consciousness gradually improved. Cranioplasty was performed on day 44. He was released from the hospital on day 215 and returned to school. Craniectomy is effective for refractory raised intracranial pressure during head trauma intensive care.